2040. Results of a National Comparative HIV QI Initiative within the VA
Henry D Anaya, PhD, VA Greater Los Angeles Healthcare System, SM Asch, VA Greater Los Angeles Healthcare System, CC Bowman,
VA Greater Los Angeles Healthcare System, A Fremont,
VA Greater Los Angeles Healthcare System, G Joyce,
VA Greater Los Angeles Healthcare System, T Korthuis,
VA Greater Los Angeles Healthcare System, S Bozzette,
VA Greater Los Angeles Healthcare System, MM Wang,
VA Greater Los Angeles Healthcare System
Objectives: As in many conditions, HIV care processes fall short of best practice recommendations. As part of the Veteranís Administration Quality Enhancement Research Initiative (QUERI), we sought to implement and evaluate two quality improvement (QI) interventions for improving HIV care: Real-time computerized clinical reminders (CR), and a collaborative intensive quality improvement program (IQS) based on the Institute for Healthcare Improvement (IHI) Breakthrough Series. The presence of an electronic medical record with pre-existing reminder software and an HIV patient registry facilitated both interventions.
Methods: The project was a four-arm quasi-experiment, using 16 VA facilities nationwide matched by organizational complexity and antiretroviral use. The control arm received the same facility-level feedback regarding HIV clinical performance that all facilities received. The remaining arms received in addition-CR, IQS, and CR+IQS. Baseline processes were calculated between May, 2000 and April 2001; post-interventional processes were measured between July, 2001 and August 2002. Eleven quality indicators were measured. In addition to measurement of clinical endpoints, the evaluation also included a qualitative process evaluation.
Results: CR arm had positive changes from baseline in 3 of 11 indicators; IQS arm for 1 of 11, and the CR+IQS arm for 3 of 11 indicators. Implementation costs were relatively small (avg. CR-$30K; IQS-$6K), as were time burdens. Participation was found to increase work satisfaction, as well as staff recognition.
Conclusions: IQS and CR participation was viewed as a positive, low burden experience. Collectively, the interventions improved many HIV clinical endpoints. Relative effectiveness of CR and IQS varied by endpoint, but CRs were most effective for screening and monitoring.